Orencia® (abatacept)

Orencia is covered only for FDA‑approved indications — adult rheumatoid arthritis, polyarticular juvenile idiopathic arthritis (≥2 years), adult psoriatic arthritis, and prophylaxis of acute GVHD in HSCT patients ≥2 years when used with a calcineurin inhibitor and methotrexate — and non‑FDA uses are excluded. Coverage requires specified prior‑therapy trials (e.g., 3 months of a biologic or a conventional synthetic DMARD for RA; trial/concurrent therapy, contraindication, or aggressive disease for JIA), appropriate prescriber specialty/consultation (rheumatologist, dermatologist, or transplant/oncology provider as applicable), documentation of donor type and concomitant GVHD meds for HSCT, adherence to age/weight‑based dosing and approval durations (initial 12 months except GVHD 30 days), and evidence of clinical benefit after ≥6 months for renewal.

"Treatment of adult patients with moderately to severely active rheumatoid arthritis."